When clients end a counseling session with ambiguous messages, the counselor must process the information and accurately determine the needs of the client, his or her safety, and the safety of others. Other examples of termination in counseling demonstrate the often unpredictable nature of the therapeutic alliance. When therapy must end prematurely, counselors must help the client gain closure as well as the necessary resources for continued successful therapeutic progress.
Case Study #1
With David, I would reflect on his history of depressive tendencies that include isolation, unsubstantiated illnesses, and increased withdrawal. Although his admonishing remarks may be a ploy or attention seeking behavior, I would be authentically concerned about letting him leave by himself without getting someone else involved. In this case, I would want to extend the session until I was certain David would be safe. I would also consider that he may recant his statements when he realizes I have as much time as needed to determine his safety. I would definitely need some insight into his ambiguous statements prior to letting him go.
Case Study #2
I would consider Melissa's deep anger toward the war because of the death of her son. Although there is a miniscule possibility that she might act on her anger, it would be extremely unusual for a woman in her position to use deadly force as a means to quell her anger (Messing & Heeren, 2004). Furthermore, I would keep in mind that she is using anger to protect her from contending with the tremendous underlying anguish from losing her son. I would consider the power of her anger and believe by presenting these somewhat ambiguous statements, Melissa is seeking validation for her anger. Her relenting agitation is a visible sign that she is having a difficult time coping with this tremendous loss.
Case Study #3
Considering this case, I understand the burden of disease is a common factor in suicide (Kerkhof, 2012) and Eva may be exploring her options for ending her life, or may already have a plan in place. In this situation, I would be well aware of her circumstances and would take some extra time, if she agreed to continuing the session to discuss any recent decisions she has made. After considering the local and other applicable laws governing my interaction with her, I would think about the value of providing my support as well as a sense of closure, at least in regard to my relationship with her. I would want to make sure she had appropriate resources and information regarding her decision.
Case Study #4
After working with Shawn for 18 months, I have a fairly good concept of his anger and how he deals with it. Although he remains distraught about the job loss, he still believes he will find a new job. I do not believe Shawn intends to hurt anyone, although his comments are ambiguous, if not threatening. I believe clarification from him would allow me to feel comfortable terminating the session. I would also consider reminding him that I have the right to break confidentiality if I honestly believe his comments are a feasible threat to one of his previous co-workers.
One Personal and Professional Challenge
Because my primary interest is working with terminally ill populations, I am certain to have clients who determine to end their own lives. It may be that the client decides to share their decision at the end of a session to avoid further discussion. Some counselors believe that when any client intimates a plan to hurt him or herself, the immediate and appropriate response is to contact authorities or make arrangements as determined by the duty to warn (Simone & Fulero, 2005). Others, however, like myself, believe otherwise. According to the American Counseling Association's (ACA) Code of Ethics (2005), in end-of-life situations, counselors have the option of deciding whether to break confidentiality when a client plans to commit suicide. Prior to working with clients who may explore end-of-life options, counselors must understand any applicable state and federal laws as well as the client's circumstances (ACA, 2005). I would certainly consider extending the session if the client were willing to do so.
Many reasons exist for termination in counseling and "finalization of the therapeutic relationship can represent a mutual loss for both the client and the therapist" (Hays, 2008, p. 161). Additionally, clients may choose to use the last few minutes of therapy to challenge the counselor with antagonizing or ambiguous information. Effective counselors develop the skills to perceive the difference between potentially catastrophic threats and harmless, albeit highly emotional states. Counselors must, however, remain aware of conceivable harmful intent.
American Counseling Association (ACA). (2005). 2005 ACA code of ethics [White Paper]. Retrieved from the ACA website: http://www.counseling.org/Files/FD.ashx?guid=ab7c1272-71c4-46cf-848c- f98489937dda
Kerkhof, A. (2012). Crisis: The Journal of Crisis Intervention and Suicide Prevention, 33(2), 63- 65. doi: 10.1027/0227-5910/a000161
Messing, J. T., & Heeren, J. W. (2004). Another Side of Multiple Murder: Women Killers in the Domestic Context. Homicide Studies, 8(2), 123-158. doi: 10.1177/1088767903262446
Simone, S., & Fulero, S. M. (2005). Tarasoff and the duty to protect. Journal of Aggression, Maltreatment & Trauma, 11(1/2), 145–168.